Apparatus and method for the detection and treatment of atrial fibrillation

Abstract

Embodiments of the invention provide methods for the detection and treatment of atrial fibrillation (AF) and related conditions. One embodiment provides a method comprising measuring electrical activity of the heart using electrodes arranged on the heart surface to define an area for detecting aberrant electrical activity (AEA) and then using the measured electrical activity (MEA) to detect foci of AEA causing AF. A pacing signal may then be sent to the foci to prevent AF onset. Atrial wall motion characteristics (WMC) may be sensed using an accelerometer placed on the heart and used with MEA to detect AF. The WMC may be used to monitor effectiveness of the pacing signal in preventing AF and/or returning the heart to normal sinus rhythm (NSR). Also, upon AF detection, a cardioversion signal may be sent to the atria using the electrodes to depolarize an atrial area causing AF and return the heart to NSR.

What is claimed is: 
     
       1. An apparatus for detection and treatment of atrial arrhythmia, the apparatus comprising:
 an electrical lead having a proximal and distal portion, the distal portion being positionable in an atrial chamber of a heart, the proximal portion having an end configured to be coupled to a pacemaker device, the lead comprising a plurality of conductive wires; 
 a plurality of membrane patches distributed along the electrical lead, each membrane patch configured to be attached to a wall of the heart and to bend and flex with motion of the heart without impeding motion of the heart; and 
 a plurality of pairs of electrodes, wherein at least one pair of electrodes is positioned on each membrane patch, the electrodes of each pair being (i) coupled to a conductive wire of the lead, and (ii) configured to at least sense an electrical signal of the wall of the heart; and 
 wherein the distribution of the plurality of membrane patches and electrode pairs along the lead is configured to allow the plurality of electrode pairs to be distributed in a pattern on the heart wall, the pattern defining an area for i) detecting a location of a foci of aberrant electrical activity located within or adjacent to the area, and ii) sending a pacing signal to that location to prevent or stop an occurrence of atrial fibrillation caused by that foci. 
 
     
     
       2. The apparatus of  claim 1 , wherein the heart wall is an endocardial wall. 
     
     
       3. The apparatus of  claim 1 , wherein the lead has a mechanical property configured to allow the lead to advanceable to the atrial chamber from a percutaneous introductory site. 
     
     
       4. The apparatus of  claim 3 , wherein the mechanical property is at least one of flexibility or pushability. 
     
     
       5. The apparatus of  claim 1 , wherein the plurality of electrode pairs include eight pairs of electrodes. 
     
     
       6. The apparatus of  claim 1 , wherein at least one of the electrode pairs includes a marker for visualizing a location of the electrode pair in the heart using a medical imaging modality. 
     
     
       7. The apparatus of  claim 1 , wherein the plurality of electrode pairs are configured and arranged in a pattern defining an area to send a simultaneous signal to the area from all of the electrode pairs to depolarize the area so as to convert a fibrillative state of the atria to normal sinus rhythm. 
     
     
       8. The apparatus of  claim 1 , wherein the plurality of electrode pairs are arranged in a circular pattern. 
     
     
       9. The apparatus of  claim 1 , wherein the plurality of electrode pairs are arranged in a pattern defining an area containing the sino-atrial (SA) node. 
     
     
       10. The apparatus of  claim 9 , wherein the plurality of electrode pairs are arranged such that the electrode pairs are at selectable distances from the sino-atrial node so that the location of the foci of aberrant electrical activity can be determined relative to the SA node. 
     
     
       11. The apparatus of  claim 9 , wherein the plurality of electrode pairs are arranged such that the electrode pairs are substantially equidistant from the SA node so that the location of the foci of aberrant electrical activity can be determined relative to the SA node. 
     
     
       12. The apparatus of  claim 1 , wherein the membrane comprises PTFE, silicone, polyurethane and/or polyester. 
     
     
       13. The apparatus of  claim 1 , wherein the membrane comprises an attachment element for attaching the membrane to the wall of the heart. 
     
     
       14. The apparatus of  claim 13 , wherein the attachment element comprises a barbed needle or a helical screw. 
     
     
       15. The apparatus of  claim 1 , wherein the atrial chamber is the right atrial chamber. 
     
     
       16. The apparatus of  claim 1 , further comprising:
 an accelerometer coupled to at least one of the conductive wires, the accelerometer positionable on an atrial wall and configured to sense motion of the atrial wall. 
 
     
     
       17. The apparatus of  claim 16 , wherein the accelerometer is configured to sense motion in three axes. 
     
     
       18. A system for the detection and treatment of atrial arrhythmia, the system comprising:
 an implantable pacemaker; and 
 the apparatus of  claim 1 , wherein at least one of the conductive wires is coupled to the pacemaker. 
 
     
     
       19. The system of  claim 18 , wherein the pacemaker includes a controller including an algorithm configured to detect the onset of atrial fibrillation based on detection of a location of the earliest depolarization occurring before that from the SA node. 
     
     
       20. The system of  claim 19 , wherein the controller includes an algorithm configured to prevent the onset of atrial fibrillation by sending a pacing signal to the location of earliest depolarization.